Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study.

AIMS: To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses. DESIGN: Mixed method explanatory sequential design. METHODS: A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena. RESULTS: Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not. CONCLUSIONS: Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety. IMPACT: Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff. REPORTING METHOD: Complied with the APA Style JARS-MIXED reporting criteria for mixed method research. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Characterizing the direct care health workforce in the United States, 2010-2019.

BACKGROUND: To describe the growth and characteristics of the direct care health workforce, encompassing home health aides, personal care aides, nursing assistants, and orderlies and psychiatric aides from 2010 to 2019 in the United States. METHODS: Using nationally representative data from the 2010 to 2019 American Community Survey, we described the growth in the direct care health workforce overall and by type of direct care health worker. In addition, we examined the distribution of direct care workers by geographic region of the country, age categories, citizenship, world area of birth, income, health insurance status, and other characteristics. RESULTS: From 2010 to 2019, the number of direct care health workers in the United States per 10,000 individuals decreased slightly from 135.81 in 2010 to 133.78 in 2019. Personal care aides made up 42.1% of the direct care health workforce in 2019, followed by nursing assistants (39.5%) and home health aides (16.3%). In 2019, the number of direct care health workers who were not U.S. citizens accounted for roughly 10% of all workers in each year. The relative percentage of direct care health workers that were not a citizen of the United States was highest among home health aides (16.3%). Among workers born outside of the United States, the majority were from Latin America, followed by Asia. CONCLUSION: From 2010 to 2019, there was little growth in the direct care health workforce despite growing demand for direct care health workers. In the midst of the current and projected shortage of direct care health workers-particularly during the COVID-19 pandemic, longer-term solutions to improve retention of direct care health workers and increase the supply of direct care health workers may be needed.

[Evolution of adherence to hand hygiene in health care professionals in a third level hospital in relation to the SARS-CoV-2 pandemic]. / Evaluación de la adherencia a la higiene de manos en profesionales sanitarios en un hospital de tercer nivel en relación con la pandemia de SARS-CoV-2.

OBJECTIVE: Proper hand hygiene is the main measure in the prevention and control of infection associated with healthcare. It describes how the pandemic period of 2020 has influenced the evolution of the degree of compliance with hand hygiene practices in health professionals at the Hospital Universitario Insular de Gran Canaria with respect to previous years. METHODS: Descriptive cross-sectional study of direct observation on compliance with the five moments of hand hygiene in the 2018-2020 period. Adherence is described with the frequency distribution of the different moments in which it was indicated. RESULTS: Total adherence has increased from 42.5% in 2018, to 47.6% in 2019, and 59.2% in 2020 (p <0.05). Total adherence was greater in the moments after contact with the patient (67%) than in the moments before contact (48%). The area with the highest adherence was dialysis (83%). There is a greater adherence in open areas than in hospitalization areas (65% vs 56%). Higher adherence was determined in physicians (73%) and nurses (74%), than in nursing assistants (50%) (p<0.05). CONCLUSIONS: In 2020 there was an increase in adherence to hand hygiene compared to previous years. A higher percentage of adherence was determined in physicians and nurses than in nursing assistants. We consider that the current SARS-CoV-2 pandemic has played a relevant role in this increase in adherence.

Enfrentamiento de la violencia en el trabajo de enfermería en el contexto hospitalario y en la Atención Primaria de Salud / Facing violence in nursing work hospital context and primary health care / Enfrentamento da violência no trabalho da enfermagem no contexto hospitalar e na Atenção Primária à saúde

INTRODUCCIÓN: La violencia en el trabajo se define como una acción, incidente o comportamiento con una actitud voluntaria del agresor, como resultado de lo cual un profesional es agredido, amenazado o sufre algún daño durante el desempeño de su trabajo. El equipo de enfermería está expuesto diariamente a situaciones de violencia en el trabajo. OBJETIVO: Comprender y analizar los mecanismos de afrontamiento de la violencia utilizados por los profesionales de enfermería en el contexto hospitalario y en la Atención Primaria de Salud. MATERIALES Y MÉTODO: Estudio explicativo secuencial mixto, con 198 trabajadores de enfermería de un hospital y 169 de atención primaria de salud, en un municipio del sur de Brasil. Los datos fueron recolectados mediante una encuesta en la etapa cuantitativa y entrevistas en la cualitativa, analizados a través del paquete estadístico de software para las Ciencias Sociales y por el análisis temático. RESULTADOS: Se identificó que el 51% de los participantes fueron víctimas de violencia, y los mecanismos de afrontamiento utilizados por los trabajadores son individuales y colectivos, con predominio del primero, lo que demuestra que el problema a menudo se dirige a la víctima. El trabajo colectivo fue un factor contribuyente en la lucha contra la violencia, con énfasis en el diálogo y el apoyo entre el equipo. Sin embargo, no hubo apoyo institucional en la búsqueda de conducta frente a episodios de violencia y consecuencias para los perpetradores. CONCLUSIÓN: La prevalencia de violencia fue alta en ambos escenarios, con diferentes características en cuanto al perfil de víctimas y perpetradores. Se refuerza la importancia del enfrentamiento colectivo, como la forma más efectiva de combatir la violencia en el lugar de trabajo

INTRODUCTION: Violence at work is defined as an action, incident, or behavior with a voluntary attitude of the aggressor, as a result of which a professional is assaulted, threatened, or suffers some damage during the performance of their work. The nursing team is exposed daily to situations of violence at work. OBJECTIVE: To understand and analyze the mechanisms of coping with violence used by nursing professionals in the hospital context and Primary Health Care.MATERIALS AND METHOD: A mixed sequential explanatory study, with 198 nursing workers from a hospital and 169 from Primary Health Care, in a municipality in southern Brazil. The data were collected using a survey in the quantitative stage and interviews in the qualitative one analyzed through the software Statistical Package for the Social Sciences and by the thematic analysis.RESULTS: It was identified that 51% of the participants were victims of violence, and the coping mechanisms used by the workers are individual and collective, with a predominance of the first, showing that the problem is often directed at the victim. Collective work was a contributing factor in tackling violence, with emphasis on dialogue and support among the team. However, there was no institutional support in the search for conduct in the face of episodes of violence and consequences for perpetrators. CONCLUSION: The prevalence of violence was high in both scenarios, with different characteristics regarding the profile of victims and perpetrators. The importance of collective coping is reinforced, as the most effective way to combat violence in the workplace

INTRODUÇÃO: A violência no trabalho é definida como ação, incidente ou comportamento com atitude voluntária do agressor, em decorrência da qual um profissional é agredido, ameaçado, ou sofre algum dano durante a realização do seu trabalho. A equipe de enfermagem, está exposta cotidianamente a situações de violência no trabalho. OBJETIVO: Analisar os mecanismos de enfrentamento da violência utilizados pelos profissionais de enfermagem no contexto hospitalar e na Atenção Primária à Saúde. Materiais e MÉTODO: Estudo misto explanatório sequencial, com 198 trabalhadores de enfermagem de um hospital e 169 da Atenção Primária à Saúde, em um município do Sul do Brasil. Os dados foram coletados utilizando-se uma survey na etapa quantitativa e entrevistas na qualitativa, analisados com auxílio do software Statistical Package for the Social Sciences e pela análise temática. RESULTADOS: Identificou-se que 51% dos participantes foram vítimas de violência, sendo os mecanismos de enfrentamento utilizados pelos trabalhadores são de cunho individual e coletivo, com predomínio do primeiro, evidenciando-se que o problema frequentemente, é direcionado à vítima. O trabalho coletivo foi um fator contribuinte para o enfrentamento da violência, com destaque ao diálogo e apoio entre a equipe. No entanto, não se observou suportes institucionais na busca por condutas frente aos episódios de violência e consequência aos perpretadores. CONCLUSÃO: A prevalência da violência mostrou-se elevada nos dois cenários, com características diferentes quanto ao perfil das vítimas e perpretadores. Reforça-se a importância do enfrentamento coletivo, como a forma mais eficaz para o combate da violência no local de trabalho

Certified Nursing Assistants' Perceived Workplace Violence in Long-Term Care Facilities: A Qualitative Analysis.

BACKGROUND: Certified nursing assistants (CNAs) provide 80% to 90% of direct care and are 23 times more likely to experience aggressive behavior from residents in long-term care (LTC) facilities than in other health care settings. The purpose of this study was to describe CNAs' perceptions of workplace violence while working in LTC facilities. METHODS: Ten CNAs were recruited from five LTC facilities through snowball sampling. A semi-structured interview was conducted with CNAs currently working in LTC facilities in Alabama. Question domains included (a) demographics, (b) residents' behavior, (c) behavior of residents with dementia, (d) experiences of verbal or physical violence from residents, (e) quality of care delivered, (f) coping strategies, (g) administrative support, and (h) training for dementia-related care challenges. The resulting transcripts were thematically analyzed. FINDINGS: CNAs described workplace violence as part of the job. They expressed a lack of administrative support as inadequate communication and a dismissal of violence against them. They regularly experienced racially charged abuse, but the perception of abuse was moderated by the presence or absence of dementia. They described a lack of training and direction to recognize and de-escalate workplace violence. CONCLUSIONS/APPLICATION TO PRACTICE: Workplace violence from residents residing in LTC facilities is an occupational health risk for CNAs. LTC facilities need a multisystem approach to reduce episodes of resident-on-CNA violence. This approach should include comprehensive training to recognize triggers of violent behavior, especially when working with individuals with dementia, as well as administrative support, and mental health resources to address the cumulative and negative consequences of racism.

Satisfaction and Technology Acceptance of Staff Regarding Use of Continuous Video Monitoring in Comparison With Sitters.

OBJECTIVE: The purpose of this study was to determine staff satisfaction and technology acceptance of continuous video monitoring (CVM) in comparison to sitters. BACKGROUND: Traditionally, sitters have been used to prevent falls in hospitals. Continuous video monitoring has emerged to reduce costs associated with sitters while maintaining safety. METHODS: A descriptive online survey using a modified version of the Technology Acceptance Model was used to gain insight on technology acceptance and satisfaction levels of clinical staff related to CVM. RESULTS: Only 12.73% found CVM to be as effective as sitters. Statistical significance was shown comparing sitters with CVM. A positive correlation was found with perceived ease of use and perceived usefulness of CVM. CONCLUSIONS: Understanding staff satisfaction and technology acceptance is imperative for nurse leaders and administration when implementing new technologies.

Trends and risk factors for infant mortality in the Lao People's Democratic Republic.

A high infant mortality rate (IMR) indicates a failure to meet people's healthcare needs. The IMR in Lao People's Democratic Republic has been decreasing but still remains high. This study aimed to identify the factors involved in the high IMR by analyzing data from 53,727 live births and 2189 women from the 2017 Lao Social Indicator Survey. The estimated IMR decreased from 191 per 1000 live births in 1978-1987 to 39 in 2017. The difference between the IMR and the neonatal mortality rate had declined since 1978 but did not change after 2009. Factors associated with the high IMR in all three models (forced-entry, forward-selection, and backward-selection) of multivariate logistic regression analyses were auxiliary nurses as birth attendants compared to doctors, male infants, and small birth size compared to average in all 2189 women; and 1-3 antenatal care visits compared to four visits, auxiliary nurses as birth attendants compared to doctors, male infants, postnatal baby checks, and being pregnant at the interview in 1950 women whose infants' birth size was average or large. Maternal and child healthcare and family planning should be strengthened including upgrading auxiliary nurses to mid-level nurses and improving antenatal care quality.

State Tested Nursing Assistants' Workplace Experiences That Threaten or Support Intent to Stay.

PURPOSE: Over 1 million Americans utilize skilled nursing facilities (SNFs) annually. Within SNFs, State Tested Nursing Assistants (STNAs) are primary caregivers; however, low retention rates are notable and threaten patient care. DESIGN: A phenomenological, qualitative study was conducted to explore intrinsic factors that influence STNAs' intent to stay in their positions. METHODS: Ten STNAs employed at for-profit SNFs participated in semistructured face-to-face interviews. Data were analyzed to identify broad concepts and recurrent themes. FINDINGS: Findings suggest that intrinsic factors supporting and threatening intent to stay included the fulfillment of basic psychological needs. Supporting themes included self-confidence, appreciation, positive relationships, and a willingness to go beyond required duties. Threatening themes included frustration, lack of support, and career advancement opportunities. CONCLUSIONS: Findings provide an understanding of factors that influence STNAs' intent to stay. CLINICAL RELEVANCE: The results may help guide the development of responsive strategies that improve quality and continuity of care in SNFs.

Tamaño muestral y significación de los coeficientes de correlación en Ciencias de la Salud / Sample size and significance of correlation coefficients in health sciences

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Qualification of palliative nursing assistance in the use of the subcutaneous route.

OBJECTIVES: to describe the experience of conducting workshops for teaching the subcutaneous fluid infusion therapy in palliative care patients. METHODS: experience report based on four workshops with a workload of nine hours each, addressing the teaching, implementation of the technique, and management in the use of subcutaneous fluid infusion therapy in patients in palliative care. The host institution was a private hospital, which had two care units in the state of Rio de Janeiro. RESULTS: we identified little knowledge about the theme. Due to the dynamics used, the workshops made it possible to qualify the participants to perform and manage the subcutaneous route in palliative care environments. CONCLUSIONS: the workshops were an important means of training, qualification, and dissemination of nursing care in a palliative care environment. The resources used to enable the qualification in the execution and management of the presented technique.

Intensity of nursing work in public hospitals.

OBJECTIVE: to analyze the intensity of nursing work in public hospitals. METHOD: cross-sectional, quantitative study, carried out in 22 public hospitals. The sample was composed of 265 nurses and 810 nursing technicians and assistants. Data were collected through a questionnaire and analyzed with Exploratory Factor Analysis. The calculation of the distribution of the work intensity by category was done using a score ranging from -1 to +1 standard deviation of the data. Fisher's exact test (0.05

Social support, role clarity and job satisfaction: a successful combination for nurses.

AIM: To analyse the moderating effect of role clarity on the relationship between social support (supervisor and colleagues) and job satisfaction. BACKGROUND: The social support of supervisors and co-workers and the clarity of roles are important antecedents of job satisfaction. According to the Conservation of Resources theory, the interaction of the instrumental nature of role clarity and social support would result in higher levels of job satisfaction in nursing. METHODS: Through a convenience sample, a final sample of 191 participants (64.92% registered nurses, 35.08% nursing assistants) was obtained from a private hospital complex in Portugal. Hierarchical linear regression models were carried out to check the moderating function of role clarity. RESULTS: Regression models showed the moderating effect of role clarity. Nursing staff with high social support from their supervisors and peers showed higher scores in job satisfaction when role clarity was high. CONCLUSION: An adequate description of roles, through clear and detailed information regarding expected functions, responsibilities and behaviour, allows the effect of social support from supervisors and co-workers on job satisfaction to be stronger. IMPLICATIONS FOR NURSING PRACTICE: Strategies such as defining responsibilities, setting clear expectations and role analysis allow a reduction in sources of uncertainty in jobs. Training in communication and feedback skills would improve the social support given by supervisors and colleagues. IMPLICATIONS FOR NURSING POLICY: Hospital boards and nurse managers should be aware of the importance of clarifying roles, responsibilities, and functions of each professional category and hierarchical level for the provision of adequate quality of care.

Work-Related Asthma Among Certified Nurse Aides in Texas.

Background: Although nurses are well described as being at risk of work-related asthma, certified nurse aides (CNAs) are understudied. Using a statewide registry in Texas, we measured prevalence and risk factors for work-related asthma and bronchial hyperresponsiveness (BHR) symptoms among CNAs. Methods: For this cross-sectional study, a questionnaire was mailed to a random sample of CNAs (n = 2,114) identified through the Texas Department of Aging and Disability Services registry, working in health care during 2016-2017, to collect data on job history, asthma symptoms, and sociodemographics. Two outcomes were defined: (a) new-onset asthma (NOA) after entry into the health care field and (b) BHR-related symptoms. Job exposures to cleaning compounds and tasks were assigned using an externally coded CNA-specific job-exposure matrix. Logistic regression modeling was used to measure associations between cleaning exposures and the two asthma outcomes. Findings: The final sample consisted of 413 CNAs (response rate 21.6%). The prevalence of NOA and BHR symptoms were 3.6% and 26.9%, respectively. In adjusted models, elevated odds for BHR symptoms were observed for patient care cleaning (odds ratio [OR] = 1.71, 95% confidence interval [CI] = [0.45, 6.51]), instrument cleaning (OR = 1.33, 95% CI = [0.66, 2.68]), building-surface cleaning (OR = 1.39, 95% CI = [0.35, 5.60]), exposure to glutaraldehyde/orthophthalaldehyde (OR = 1.33, 95% CI = [0.66, 2.68]), and latex glove use during 1992-2000 (OR = 1.62, 95% CI = [0.84, 3.12]). There were too few NOA cases to warrant meaningful regression analysis. Conclusion/Application to Practice: Although not statistically significant, we observed elevated odds of BHR symptoms among nurse aides, associated with cleaning exposures, suggesting this is an at-risk group of health care professionals for work-related respiratory disease, meriting further study.

The effect of function-focused care on long-term care workers in South Korea.

The purpose of this study was to identify the effects of the Korean Function-Focused Care Program (K-FFCP) for residents of long-term care facilities (LTCRs) on long-term care workers' (LTCWs) knowledge, self-efficacy, and outcome expectations about function-focused care, as well as on their job satisfaction. The study adopted a quasi-experimental repeated-measures design. Participants included 50 LTCWs from two long-term care facilities (24 in the experimental group and 26 in the control group). Multivariate analysis of covariance showed that the effects of K-FFCP were significant on knowledge, efficacy, outcome expectation, and job satisfaction. Outcomes that could not be measured using scales were assessed through a focus group interview. The results suggest that LTCWs would benefit from a long-term educational program on function-focused care.

Essential Long-Term Care Workers Commonly Hold Second Jobs and Double- or Triple-Duty Caregiving Roles.

OBJECTIVES: Long-term care (LTC) facilities are particularly dangerous places for the spread of COVID-19 given that they house vulnerable high-risk populations. Transmission-based precautions to protect residents, employees, and families alike must account for potential risks posed by LTC workers' second jobs and unpaid care work. This observational study describes the prevalence of their (1) second jobs, and (2) unpaid care work for dependent children and/or adult relatives (double- and triple-duty caregiving) overall and by occupational group (registered nurses [RNs], licensed practical nurses [LPNs], or certified nursing assistants [CNAs]). DESIGN: A descriptive secondary analysis of data collected as part of the final wave of the Work, Family and Health Study. SETTING: Thirty nursing home facilities located throughout the northeastern United States. PARTICIPANTS: A subset of 958 essential facility-based LTC workers involved in direct patient care. MEASUREMENTS: We present information on LTC workers' demographic characteristics, health, features of their LTC occupation, additional paid work, wages, and double- or triple-duty caregiving roles. RESULTS: Most LTC workers were CNAs, followed by LPNs and RNs. Overall, more than 70% of these workers agreed or strongly agreed with this statement: "When you are sick, you still feel obligated to come into work." One-sixth had a second job, where they worked an average of 20 hours per week, and more than 60% held double- or triple-duty caregiving roles. Additional paid work and unpaid care work characteristics did not significantly differ by occupational group, although the prevalence of second jobs was highest and accompanying work hours were longest among CNAs. CONCLUSION: LTC workers commonly hold second jobs along with double- and triple-duty caregiving roles. To slow the spread of COVID-19, both the paid and unpaid activities of these employees warrant consideration in the identification of appropriate clinical, policy, and informal supports. J Am Geriatr Soc 68:1657-1660, 2020.